342700369-4-5-2022-27-AS-KHOS-CD9N93-20220407101517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700369
Report Date: 04/05/2022
Date Signed: 04/05/2022 04:49:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/02/2022 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20220202133533

FACILITY NAME:	COMMONS AT ELK GROVE, THE		FACILITY NUMBER:	342700369
ADMINISTRATOR:	COURTNEY HILL		FACILITY TYPE:	740
ADDRESS:	9564 SABRINA LANE		TELEPHONE:	(916) 683-6833
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	110	CENSUS: 86	DATE:	04/05/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Meggin Newman Cortez, Executive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility has inadequate food service

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude the investigation on 4/5/22 at 12:15pm. LPA met with Executive Director (ED), Meggin Cortez and stated the purpose of the visit. Upon arrival LPA and ED toured the physical plant. Regarding allegation, "Facility has inadequate food service", LPA observed residents eating lunch which contained brussels sprouts, green beans, ribs, egg sandwich and vegetables, tea, and water. Based on LPA observation each plate of the residents were very full of food during this visit. LPA also observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained which included water on the premises during this visit.
Based on observation during todays visit and lack of evidence the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED.
A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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